Author Archives: stfmguestblogger

The 3-Year Curriculum: Disruptive Innovation and the Change Imperative From Texas Cowboy Boots on the Ground

Betsy Goebel Jones, EdD

Betsy Goebel Jones, EdD

For the past 5 years, I have been intimately involved with the Family Medicine Accelerated Track, or FMAT, at Texas Tech University Health Sciences Center School of Medicine (TTUSOM), so I’m always interested when an item lands in my Twitter feed or inbox about 3-year medical school curricula. As a result, it’s been hard to ignore the irony of not one but two Perspective articles in the September 19 New England Journal of Medicine (by Abramson et al.) and (Goldfarb and Morrison) and at least one prominent blog post (by Pauline Chen), all prompted by NYU’s launch of a 3-year pathway to the MD—and just as I was preparing for the AAMC meeting in Philadelphia that had as its theme “The Change Imperative.”

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Getting to Know You, Getting to Know All About You: Best Practices for Interviewing Fourth-Year Medical Students for Residency Programs

Kristine M. Diaz, PsyD

Kristine M. Diaz, PsyD

Thirty minutes. Thirty minutes to assess an applicant’s interpersonal and communication skills, emotional intelligence, reasons for applying to your residency program, determine if there are any red flags, talk about application materials (don’t forget to comment on that personal essay!), AND answer any questions the applicant has about your program. Oh, don’t forget to recruit for your program! Yeah. Thirty minutes. That’s all the time you get. Sounds, easy? Right?!

While many websites and online documents exist that address succeeding in residency interviews for applicants, there are no guidelines or best practices with conducting the residency interview for faculty members in residency programs. The lack of guidance in conducting the interview may lead to variability in the assessment of the applicant. This variability may also lead to a poor experience for the interviewee. How does one judge the fit of an applicant in a short amount of time?

Medical schools have developed varied approaches to the interviewing process for entry to medical school. Yet, residency programs appear to vary in their approaches to the selection process, particularly the on-site interview. A systemic and individual-based program approach may be considered in the interviewing process of applicants, using ACGME milestones and the interview itself as an opportunity to evaluate your program’s success in the development of a distinct health care professional in the competitive field of medicine.

Focus on these four areas to strengthen your residency’s interview process.

The mission, values, and goals of your residency program

Time should be spent as an entire faculty, discussing the mission, values, and goals of your residency program. ACGME accreditation standards provide a common foundation for all residencies to function and operate in the development of residents in training. However, your faculty and the program’s composition of residents and staff provide an opportunity to create its own identity as a program separating the lion from the crowd. Your identity as a program will help to generate a rubric to which you have made your selections for on-site applicant interviews.

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Are We Teaching Template-Based Medicine? The Forest and the (Very Well Documented!) Trees

Bill Cayley, Jr

Bill Cayley, Jr,
MD MDiv

With the increasing use of electronic medical records (EMRs) and their ever-so-helpful templates, smart-sets, and forms for capturing information needed to support billing and guide protocols, I fear we are losing the narrative forest for the well-documented trees. Especially in family medicine, we have a long tradition of teaching our learners to appreciate narrative and nuance, and the flow of meaning and story that comes from a patient’s history can give far more insight into what may be going on than one gets from simple documentation of location, quality, quantity, etc. Now, however, our use of EMRs is pushing us more and more to documentation of positives and negatives, rather than story.

Case in point #1: As emergency room documentation has moved toward templates and away from dictation, I have found ER notes growing in length, yet declining in their ability to convey meaningful information. Documentation of an ER visit that in the past was captured by a one- or two-page dictated note, now comes in a eight- or nine-page template document that gives no real clue as to what really brought the patient in or what really happened.

Case in point #2: As EMRs use templates to guide information gathering, how often do you find yourself responding to the template in an office visit, or ordering something “because it is there,” rather than listening to the patient’s story? Continue reading